Second birth - what would you do if you were me? (VB v ELCS)

[ShadowPuppets]

First birth was DD in August 2020. Long early labour during which I couldn't sleep, so by the time I was admitted I hadn't slept for 3 days. Really didn't deal with the pain very well - I usually have a relatively high pain threshold but the lack of sleep really did me in - I was screaming for the epidural at 3cm. Epidural worked well but labour slowed dramatically, eventually got to 10cm but the top up failed so I gave birth with just gas and air. Pushing stage went on for 2.5 hours and consultant came in, it was agreed forceps would be necessary but they wanted to do it in theatre in case I needed an EMCS. By the time they were about to move me DD had moved down a lot so they did forceps in the room with episiotomy. Significant blood loss, just shy of counting as a PPH. DD weighed just over 4kg / nearly 9lb. When she came out I was mentally and physically shattered, I just kept saying 'have I hurt her' because I was convinced I had 'failed' at birthing her which was why she needed to be pulled out with the forceps. I was too shaky to hold her and all I wanted to do was sleep. It took me a long time to bond with her after birth because all I wanted to do was have someone take the baby away so I could recover, which I feel awful about now. I also have a mild prolapse for which I've been on a waiting list for a women's physio appointment for months (still waiting!).

So, cue birth number 2. Before I became pregnant I was convinced if I was ever going to birth again I would be requesting an ELCS because I just didn't want to risk going through that experience again. I've raised this at every midwife appointment since and I'm booked in to discuss with the midwives (then referred onto the consultant for sign off) in the next few weeks (I'm currently 26 weeks).

But I'm wavering! Here's my current list of pros and cons for an ELCS:

Pros:

• Much calmer experience and less likely to impact on my MH / bonding with baby (MH was really poor until DD was about 6 months, mostly I think due to the pandemic but her birth was a big factor too)
• Smaller risk of further pelvic floor damage
• Risk of large baby given DD's size
• Risk of epidural failure after last time - I really couldn't handle the pain well but maybe this time would be different if latent labour didn't last so long?
• Was very close to an EMCS last time - what if I try for a VB and then wind up with a CS anyway?
• Feeling more in control rather than risking a repeat of DD's birth
• Easier to organise childcare for DD (obviously this is a minor factor but she'll only be 21 months old and there's only one person who could have her, and she's never stayed there overnight - we are doing a trial run next month though).

Cons:

• Lots of people have instrumental first births and then really trouble free second births
• As much as mentally my recovery was really hard last time and I'm still struggling with the prolapse, the actual healing from the episiotomy/birth was quite quick - I'm concerned about recovery time for an ELCS
• Added to that the challenge of picking up DD after an ELCS - she's still small and won't get that I can't lift her (DH should be around for 4 weeks after the birth though which would help)
• Postnatal ward was hell on earth last time - if I can do anything to avoid a long stay I'd like to, and I know I'll have a longer stay with an ELCS than a VB
• Selfishly, I understand that your stomach/body is more likely to recover to something vaguely resembling its pre-pregnancy self after a VB - obviously not quite the same as before, but after DD I wouldn't have said my figure was much different to before her (with clothes on at least!)
• All the midwives (including one of my best friends, who is a midwife) are telling me there's no reason why I wouldn't have a trouble free birth this time around.

I just feel really confused, I'd love to be one of those people who has a straightforward second birth which lays to rest the ghosts of the first one. On the flip side, I just feel like I'd be so upset if birth 2 goes the same way as birth 1 and I could have done something to make it calmer. Equally, physical recovery is a big factor this time around and the idea of recovering from a straightforward birth with just a graze or a couple of stitches is much more appealing than a CS recovery, especially with a toddler around.

I'm really on the fence and don't feel like I can discuss this with my healthcare team because they are very pro me having a second VB.

What would you do if you were me? Does anyone have any second birth regrets after something like my first?

I had an ELCS with my first (breech baby) and I'm planning to have one again. It was very calm and was it was done very quickly (45 mins after I walked into theatre I had the baby on my chest while they stitched me up!). I only had to stay in for 2 nights afterwards. I healed very quickly and they gave me good pain meds for the first few days. I bonded well with my baby and was able to breast feed ok.

I do have a sort of shelf that I can feel in my stomach muscles that I guess is where the incision went internally (it's higher up than the external scar) but I can't say it's affected me long term and it's not noticeable under clothes.

I hope this helps, both options have pros and cons as you have said.

How many children would you like OP?

I have had three c-sections. First was for breech baby. Second was elective, everything that could go wrong went wrong and my DS ended up in special care (as a direct result of the c-section- although this is reasonably rare). Third baby I got no choice, third section.

My body recovered well after the first two. The third was harder and I now have excess skin.

Furthermore, I would like a fourth child but I am very scared of another c-section and it's also not recommended.

Thanks both, that's really helpful. @NetflixAndSauvignonBlanc I'm reassured by the fact that you've had one and would have a second!

@Dogsandbabies DH says we're done at 2 and reckons he's off for the snip once DS is born. I've said I'd willingly have a 3rd if our financial circumstances changed - not dramatically, but I think two to three would take us from 'comfortable' to 'just about managing'. So I'd say this is almost certainly my last birth unless we win the lottery and I manage to win DH over!

I'm sorry about your second birth, that sounds really traumatic I've heard that about multiple CSs not being advised - my mum had two with my sister and I and was advised a third might not be the best idea. I suppose there's only a certain number of times you can put your body through that sort of surgery - I'm trying to force myself not to be blasé about it, because I know it's easy to think of it as an easier option. Although given my first birth, I wonder if it's just that a ELCS isn't an 'easier' option than your 'normal' birth, and maybe it would have been an 'easier' option on balance than DD's birth. Really tricky.

*your average 'normal' birth

My friend had a birth like yours for her first but the second was completely different. Quick Labour, easy delivery and no tears. She was home 6 hours after and even attended a birthday party with her other child day 5- i was in totally awe! I had a section for my first after a full Labour and getting to fully dilated and although the recovery wasn’t as awful as I had prepared, the thought of recovering whilst simultaneously trying to care for my toddler would personally make me consider VBAC over another section the preferable option.

Your first birth experience is very similar to mine. I chose an ELCS for my second and it was amazing. It was calm, controlled and healing from the trauma of my first. Recovery was fine, I just kept up with the pain killers and didn’t do too much. If I had another there is no question for me, I’d have another ELCS.

Also to add DD was born at 10am and I was home by 11am the next day.

Prolapses are unlikely to get worse with births... unfortunately pregnancies do a lot of the damage.

Could you come to a compromise with your team...I.e. aim for spontaneous labour/birth but if it is looking like an instrumental delivery then you would decline and opt for a C/S? This is an option (I'm a midwife). I would say the majority of women with a first vaginal birth instrumental or not, have a relatively uncomplicated second birth.

Its a really tricky decision OP. I was recently in the same boat of having to choose C/S or vaginal birth due to previous birth complications. I deliberated for a long time and opted for the vaginal birth in the end but I did think about the "what ifs" during labour.

I had a forceps delivery with my first and opted for an elective section for my second (next week Tuesday - eeeeeeek).
I'm just so afraid of having another instrumental delivery if I try for a vaginal birth and don't have much trust that the decision for a CS would be made in time during my labour to avoid another forceps delivery.

My first labour had a lot of similarities to yours. Long, epidural (mine failed once I got to 10cm), couldn't push, episiotomy, forceps in theatre, 1l PPH. Although I don't think my physical recovery was too bad considering, the emotional recovery was horrendous mostly due to the exhaustion and the postnatal ward being hell on earth as you say.

The physical recovery with a toddler and the guaranteed stay on postnatal were the main reasons I didn't want a section the second time.

Second labour was a breeze in comparison honestly. Felt like I could have done it again and would have happily got up and left immediately after I had DS2. He was waiting for no one though! 2 hours 41 minutes from first niggle. I did have a second degree tear which was no surprise considering the speed but the recovery has been nothing compared to the episiotomy.